How can I access MELISA testing for my patients?
A test kit can be ordered by yourself or your patient here. After the blood draw, the sample must immediately be sent to a licensed MELISA laboratory, arriving within 48 hours and before the weekend.
How much does MELISA cost and when will the results be ready?
To see prices and which metals can be tested, please see below
For MELISA testing in Europe, please contact our labs listed HERE directly.
Results are ready within 10-14 days. You will receive an invoice as soon as your results are ready. You can pay securely by credit or debit card. Results cannot be released until payment is received.
How should I choose what metals to test for?
Typically, the choice of metals for testing will be based on the patient’s current exposure.
Patients should ideally find out the exact composition of their fillings, crowns, wires, pins and/or implants.
The testing panels offered by MELISA laboratories have been devised to include the most commonly found allergy-causing metals in various metal alloys used in dentistry and surgery.
On this page you will find an overview of metals found in frequently used dental and orthopaedic restorations as well as an overview of metals present in our environment.
There are a few things to consider if your patient is testing before having an implant placed. MELISA testing can only measure current immune reactivity and cannot guarantee that an allergy will not develop during in vivo, long-term, high-level metal exposure post-surgery.
How much blood is needed for the MELISA test?
A MELISA laboratory typically needs 20-70 ml of blood depending on the number of metals to be tested. The blood must be drawn into special tubes containing sodium citrate (an anti-coagulant). Blood should be kept at room temperature and NOT centrifuged. Patients with low white blood cell count should provide more volume (1-2 extra tubes) so the lab can obtain enough cells from the sample.
Number of 9 ml citrate tubes needed:
1-3 metals use 2 tubes
4-6 metals use 4 tubes
7-10 metals use 5 tubes
11-15 metals use 6 tubes
16-20 metals use 7 tubes
1-3 serum tubes (8 ml) should also be included.
What medication can affect the test results?
MELISA testing measures an immune response. Any drug that suppresses the immune system may affect test results. Certain medication, such as steroids, must be avoided for 3 weeks to ensure accurate results. For a list of medication and factors that may affect testing, see medication.
What is the MELISA test?
MELISA® (MEmory Lymphocyte Immuno-Stimulation Assay) is a modified, optimised and clinically validated version of lymphocyte transformation testing. It was originally developed for the diagnosis of occupational allergies at Astra Pharmaceuticals (now AstraZeneca) but is now mainly used to measure lymphocyte reactivity to metals (a Type IV cell-mediated reaction). For testing, whole blood needs to be drawn into tubes containing sodium citrate (an anti-coagulant).
What information can the MELISA test provide?
Inflammation activated by metal hypersensitivity may be one of the causes of ill health in patients. MELISA can identify if metals are causing an immune reaction, which may affect health. Most relevant results are obtained when testing is based on current exposure to metals found in fillings, crowns, orthopedic devices, pacemakers, Essure, occupational exposure etc. Studies show that if metal allergy is found, many symptoms will improve or disappear if exposure to relevant metals is reduced.
In which fields of medicine does metal hypersensitivity play an important role?
Orthopedic and general surgery; dentistry; occupational medicine and environmental health, among others.
Metals are found in body implants such as hip joints, knee prosthesis, screws, pacemakers, silicone breast implants, cochlear implants and dental implants. In most patients, these implants are biocompatible. However, in sensitive patients, the implants may induce side-effects such as pain, dermatitis, cutaneous swelling, impaired wound healing and implant loosening. Excessive fatigue can be due to chronic inflammation due to metal ions released from implants.
Which symptoms may indicate metal allergy?
The classic symptom of metal hypersensitivity is allergic contact dermatitis. In addition to local symptoms, chronic exposure to metals may cause numerous symptoms associated with an overactive immune system in susceptible people. Patients with metal hypersensitivity report symptoms such as inflammation, joint and muscle pain, cognitive impairment (brain fog), depression, and headaches. Metal hypersensitivity has been implicated in the aetiology of chronic fatigue syndrome, autoimmune diseases, fibromyalgia and multiple chemical sensitivity.
Why is metal exposure problematic for some individuals?
Metals are potential allergens. The binding of metal ions to proteins can alter the protein activity and surface structure of these enzymes, thereby inducing local or systemic symptoms. In contrast to a Type I allergy, which is mediated by IgE antibodies, a Type IV allergic reaction is mediated by T lymphocytes that have had prior contact to a given allergen (memory lymphocytes). Following renewed contact with the sensitising allergen, these memory lymphocytes respond by enlarging (lymphoblast transformation) and dividing (proliferation). The newly formed cells (effector cells) together with their secreted cytokines mediate the resulting inflammatory reaction.
How can metal hypersensitivity be diagnosed?
Metal hypersensitivity is traditionally diagnosed by patch testing, but this can be problematic when testing irritative substances such as mercury, or substances with large particles like titanium dioxide.
Studies show that lymphocyte transformation tests are better suited for diagnosing possible metal sensitivity than traditional patch testing. Implant-related hypersensitivity reactions are mediated by sensitized T cells and the relationship between skin hypersensitivity and systemic hypersensitivity is ill defined. Lack of standardization in patch testing may also contribute to reduced reliability.
Using MELISA avoids many of the issues surrounding patch testing.
What is the MELISA testing procedure?
Blood in citrate tubes must arrive at the laboratory ideally within 24 hours after the blood has been drawn (maximally within 48 hours). White blood cells (lymphocytes) are isolated and tested against allergens chosen accordingly to the patient’s anamnesis and exposure to metals. The blood is incubated for five days and the lymphocyte reaction is measured in two ways: one based on the uptake of radioisotopes by dividing lymphocytes; the other by microscopic evaluation. The level of reactivity is measured as a Stimulation Index (SI). A value over 3 indicates a positive reaction to a given allergen. The results are available in ten days.